The Patient Self-Detennination Act (PSDA) is now in effect, but it leaves many clinical, ethical, and legal questions unanswered. Until the Health Care Financing Administration develops implementation regulations, fair and appropriate enforcement of the Act will be impossible.
The PSDA gives patients the right to choose the extent of their health-care treatment, yet crucial questions have not been addressed. For example, is admission the most appropriate time to approach patients about advance directives? Who should provide the required information? What should be done for patients who cannot understand written materials? Who will ensure that the patient's directives are carried out?
Nurses can take steps to successfully implement the PSDA. Because nurses are effective patient advocates, they should be members of bioethics and nursing ethics committees. Formal education programs should be developed to ensure that all health-care professionals fully understand the Act as well as state statutes on advance directives. Surveys have shown that a large percentage of health professionals are unfamiliar with these areas.
Nurses should also participate in hospitalwide multidisciplinary committees to develop institutional policies and procedures for advance directives. Ongoing educational programs and ethical consultation should be available regarding patient autonomy and withdrawal of lifesustaining treatment [AACN News 1992; March:3].